E1235 — Wheelchair, pediatric size, rigid, adjustable, with seating system
HCPCS Level II E-code · short descriptor: “Rigid ped wc adjustable”
- Code system
- HCPCS Level II
- Family
- E — Durable medical equipment
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Capped rental
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
E1235 Medicare fee schedule (April 2026)
RR — Monthly rental Capped rental
Medicare allowable ranges from $264.72 to $317.70 depending on state and rural status.
Former-CBA payment limits: ceiling $264.72 · floor $225.01
| State | Non-rural | Rural |
|---|---|---|
| AK | $264.72 | — |
| AL | $264.72 | — |
| AR | $264.72 | — |
| AZ | $264.72 | — |
| CA | $264.72 | — |
| CO | $264.72 | — |
| CT | $264.72 | — |
| DC | $264.72 | — |
| DE | $264.72 | — |
| FL | $264.72 | — |
| GA | $264.72 | — |
| HI | $264.72 | — |
| IA | $264.72 | — |
| ID | $264.72 | — |
| IL | $264.72 | — |
| IN | $264.72 | — |
| KS | $264.72 | — |
| KY | $264.72 | — |
| LA | $264.72 | — |
| MA | $264.72 | — |
| MD | $264.72 | — |
| ME | $264.72 | — |
| MI | $264.72 | — |
| MN | $264.72 | — |
| MO | $264.72 | — |
| MS | $264.72 | — |
| MT | $264.72 | — |
| NC | $264.72 | — |
| ND | $264.72 | — |
| NE | $264.72 | — |
| NH | $264.72 | — |
| NJ | $264.72 | — |
| NM | $264.72 | — |
| NV | $264.72 | — |
| NY | $264.72 | — |
| OH | $264.72 | — |
| OK | $264.72 | — |
| OR | $264.72 | — |
| PA | $264.72 | — |
| PR | $317.70 | — |
| RI | $264.72 | — |
| SC | $264.72 | — |
| SD | $264.72 | — |
| TN | $264.72 | — |
| TX | $264.72 | — |
| UT | $264.72 | — |
| VA | $264.72 | — |
| VI | $264.72 | — |
| VT | $264.72 | — |
| WA | $264.72 | — |
| WI | $264.72 | — |
| WV | $264.72 | — |
| WY | $264.72 | — |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%.
A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area
adjustments and non-continental rates can differ — verify with your DME MAC.
Common denial codes to watch
Related E-codes
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